Speciality
Spotlight

 




 


Oncology


 

 





Haematology

     

  • Villeval J-L, Cohen-Solal K, Tulliez M, et al [Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris; Hopital Henri Mondor, Creteil, France]

    High Thrombopoietin Production by Hematopoietic Cells Induces a Fatal Myeloproliferative Syndrome in Mice

    Blood 90 : 4369-4383, 1997

                               

    The long term, high dose thrombopoietin in mice in early phase led to increase platelet count, WBC increased tenfold and hematocrit decreased to 29%. At approximately 10 weeks the numbers of WBC platelets and RBC decreased significantly.

                                   

    In several organs extramedullary hematopoieses, severe fibrosis and osteosclerosis
    was observed in the spleen and bones. These findings do indicate that high and persistent production of thrombopoietin by transducted hematopoietic stem cells in mice causes a fatal myeloproliferative disorder that shares features with human idiopathic
    myelofibrosis.

                   

  • Ohene-Frempong K, and the Co-operative Study of Sickle Cell Disease [Children’s Hosp of Philadelphia]

    Cerebrovascular Accidents in Sickle Cell Disease: Rates and Risk Factors

    Blood 91: 288-294, 1998

                                       

    Cerebrovascular accidents [ CVA] is a major complication in patients with sickle cell disease [SCD].

                         

    This large co-operative study analysed the data in 4082 patients with SCD with mean follow-up of 5.2 years. Patients with sickle cell anemia [SS] has the highest incident in 20-29 years and rate of death within 2 weeks after hemorrhagic stroke was 26% in all age groups. None died with infarctive stroke. 

         

    The occurrence of CVA is considered absolute indication of chronic transfusion therapy designed to increase normal hemoglobin A.

                                                             
        

  • Cocco P, Todde P, Fornera S, et al [ Universita di Cagliari, Italy; Ospedale S Michele, Cagliari, Italy : Servizio di Pubblica, S Gavino Monreale, Italy]

    Mortality in a Cohort of Men Expressing the Glucose-6-Phosphate dehydrogenase Deficiency

    Blood 91: 706-709, 1998

                 

    Glucose-6-phosphate dehydrogenase [G6PD] is a cytoplasmic enzyme that may be associated with lower mortality in cancer and cardiovascular diseases. 

                                   

    In this large study consisting of 1756 males with G6PD pheno type from Health Department of Regional Administration of Sardinia were evaluated.

                                    

    There was a reduction in deaths from ischemic heart disease, cerebrovascular diseases and liver cirrhosis and significant 5.4 fold rise in mortality from Hodgkin’s
    Lymphoma.

                               

  • Clarke
    M, and the Early Breast Cancer Trialists’ Collaborative
    Group [Radcliffe Infirmary, Oxford, England]

    Tamoxifen for Early Breast Cancer: An Overview of the
    Randomized Trials


    Lancet 351: 1451-1467, 1998

                         

    Treatment with adjuvant tamoxifen yielded notable
    improvement in 10-year survival rates in women with
    ER-positive tumours and in women with tumours of unknown
    ER status. These women also have proportional reductions
    in breast cancer recurrence and mortality that seem to
    be unaffected by other patient characteristics or
    treatments.                

                                                                                                    

  • Marsh J, for the EBMT Severe Aplastic Anaemia Working Party (St George’s Hosp Med School, London)

    Prospective Randomized Multicenter Study Comparing Cyclosporin Alone Versus the Combination of Antithymocyte Globulin (ATG) and Cyclosporin for Treatment of Patients With Nonsevere Aplastic Anemia: A Report From the European Blood and Marrow Transplant (EBMT) Severe Aplastic Anaemia Working Party 

    Blood 93: 2191-2195, 1999

                                                                                                

    Patients with nonsevere aplastic anemia received ATG + cyclosporin or cyclosporin alone and hematologic response at 6 months was recorded.

                                                                                

    Those receiving combination of ATG + cyclosporin had significantly higher median hemoglobin level than patients receiving cyclosporin alone and those on cyclosporin alone had significant disease progression within 6 months.

                                                                                       

    Thus combination arm had higher responses and complete responses and transfusion-free survival.                

                                                                              

  • Dunn DE, Tanawattanacharoen P, Boccuni P, et al (Natl Heart, Lung, and Blood Inst, Bethesda, Md; MCP Hahnemann Univ, Philadelphia)

    Paroxysmal Nocturnal Hemoglobinuria Cells in Patients With Bone Marrow Failure Syndromes

    Ann Intern Med 131: 401-408, 1999

                                                                                

    Aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH) are rare hematologic diseases that commonly occur in the same patient.

                                                                                             

    This study of patients with diverse marrow failure such as aplastic anemia with MDS, post BMT, cancer treated with chemotherapy etc were examined for PNH status by flow cytometric analysis.

                                                                                                                      

    Evidence of PNH was observed in 22% of patients with aplastic anemia, 23% patients with MDS. The presence of PNH cells i.e. GPI anchored protein deficient cells were predictive of response to ATG.                                        

                                    

  • Somlo G, Sniecinski I, ter Veer A, et al (City of Hope Natl Med Ctr, Duarte, Calif; Mayo Clinic Cancer Ctr, Rochester, Minn; Genentech Inc, South San Francisco)

    Recombinant Human Thrombopoietin in Combination With Granulocyte Colony-Stimulating Factor Enhances Mobilization of Peripheral Blood Progenitor Cells, Increases Peripheral Blood Platelet Concentration, and Accelerates Hematopoietic Recovery Following High-Dose Chemotherapy

    Blood 93: 2798-2806, 1999

                                                                                                       

    This phase I study of varying dose schedule of rhTPO with G-CSF revealed enhanced mobilization of PBPC, higher peripheral blood platelet count and platelet count of PBPC product.

                                                                      

    Most beneficial to the patients were decrease in the number of apheresis procedures and transfusions required following high dose chemotherapy.                                         

                                                                                      

  • Navarro JF, Mora C, Garcia J, et al (Hosp Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain)

    Effects of Pentoxifylline on the Haematologic Status in Anaemic Patients With Advanced Renal Failure

    Scand J Urol Nephrol 33: 121-125, 1999

                                                                                                            

    Erythropoietin (EPO) deficiency is one of the cause of anemia in patients with renal failure. Inhibition of EPO by cytokines such as
    TNF-
    a (tumor necrosis
    factor-
    a) may also play some role. Pentoxifylline inhibits
    TNF-
    a

                                                                                                              

    This study of 12 patients with anemia and advanced renal failure were randomized to control group and active treatment group i.e. with pentoxifylline (TF) 400 mg/day for 6 months. Daily PTF group had significant higher hemoglobin level and hematocrit along with reduced
    TNF-
    a levels.                                                              

                                                                                                                                                                                                          

  • Gonzalez-Fajardo JA, Arreba E, Castrodeza J, et al (Hosp Clinico Universitario, Valladolid, Spain)

    Venographic Comparison of Subcutaneous Low-Molecular Weight Heparin (LMWH) With Oral Anticoagulant Therapy in the Long-term Treatment of Deep Venous Thrombosis 

    J Vasc Surg 30: 283-292, 1999

                                                                                                                                                       

    This open randomized clinical trial of 165 patients of deep vein thrombosis randomized to LMWH or oral anticoagulant. Those on oral anticoagulant had received standard unfractionated heparin at the onset. 

                                                                                                                      

    LMWH was associated with significantly improved resolution of venous thrombosis which could be associated with reduced long term complications from the post-phlebitic syndrome.                                                                                                                    

                                                                                

  • Hebert PC, for the Canadian Critical Care Trials Group (Univ of Ottawa, Hamilton; et al)

    A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care

    N Engl J Med 340: 409-417, 1999                

                                                                                                                              

    This study of 838 critically ill patients who were normovolemic were randomly assigned to either a restrictive strategy (transfusion when hemoglobin concentration decreased below 7 gm/dL) or a liberal strategy (transfusion when hemoglobin decreased below 10
    gm/dL).                                                   

                                                                                  

    There was no difference in early (30 day death) or late mortality (60 day death) and mortality rate overall for hospitalization was lower in patients transfused with the restrictive policy.                                                  

                                                                                

    This study clearly indicates superiority of restrictive policy versus liberal policy in critically ill normovolemic patients.       

                                                            

                                                                             

                                                                                         





                                    

                        

                                                                                   

                                  

     


 

 



 

 

Speciality Spotlight

 

 

Haematology
     

  • Villeval J-L, Cohen-Solal K, Tulliez M, et al [Institut Gustave Roussy, Villejuif, France; Hopital Cochin, Paris; Hopital Henri Mondor, Creteil, France]
    High Thrombopoietin Production by Hematopoietic Cells Induces a Fatal Myeloproliferative Syndrome in Mice
    Blood 90 : 4369-4383, 1997
                               
    The long term, high dose thrombopoietin in mice in early phase led to increase platelet count, WBC increased tenfold and hematocrit decreased to 29%. At approximately 10 weeks the numbers of WBC platelets and RBC decreased significantly.
                                   
    In several organs extramedullary hematopoieses, severe fibrosis and osteosclerosis was observed in the spleen and bones. These findings do indicate that high and persistent production of thrombopoietin by transducted hematopoietic stem cells in mice causes a fatal myeloproliferative disorder that shares features with human idiopathic myelofibrosis.
                   

  • Ohene-Frempong K, and the Co-operative Study of Sickle Cell Disease [Children’s Hosp of Philadelphia]
    Cerebrovascular Accidents in Sickle Cell Disease: Rates and Risk Factors
    Blood 91: 288-294, 1998
                                       
    Cerebrovascular accidents [ CVA] is a major complication in patients with sickle cell disease [SCD].
                         
    This large co-operative study analysed the data in 4082 patients with SCD with mean follow-up of 5.2 years. Patients with sickle cell anemia [SS] has the highest incident in 20-29 years and rate of death within 2 weeks after hemorrhagic stroke was 26% in all age groups. None died with infarctive stroke. 
         
    The occurrence of CVA is considered absolute indication of chronic transfusion therapy designed to increase normal hemoglobin A.
                                                                  

  • Cocco P, Todde P, Fornera S, et al [ Universita di Cagliari, Italy; Ospedale S Michele, Cagliari, Italy : Servizio di Pubblica, S Gavino Monreale, Italy]
    Mortality in a Cohort of Men Expressing the Glucose-6-Phosphate dehydrogenase Deficiency
    Blood 91: 706-709, 1998
                 
    Glucose-6-phosphate dehydrogenase [G6PD] is a cytoplasmic enzyme that may be associated with lower mortality in cancer and cardiovascular diseases. 
                                   
    In this large study consisting of 1756 males with G6PD pheno type from Health Department of Regional Administration of Sardinia were evaluated.
                                    
    There was a reduction in deaths from ischemic heart disease, cerebrovascular diseases and liver cirrhosis and significant 5.4 fold rise in mortality from Hodgkin’s Lymphoma.
                               

  • Clarke M, and the Early Breast Cancer Trialists’ Collaborative Group [Radcliffe Infirmary, Oxford, England]
    Tamoxifen for Early Breast Cancer: An Overview of the Randomized Trials
    Lancet 351: 1451-1467, 1998
                         
    Treatment with adjuvant tamoxifen yielded notable improvement in 10-year survival rates in women with ER-positive tumours and in women with tumours of unknown ER status. These women also have proportional reductions in breast cancer recurrence and mortality that seem to be unaffected by other patient characteristics or treatments.                
                                                                                                    

  • Marsh J, for the EBMT Severe Aplastic Anaemia Working Party (St George’s Hosp Med School, London)
    Prospective Randomized Multicenter Study Comparing Cyclosporin Alone Versus the Combination of Antithymocyte Globulin (ATG) and Cyclosporin for Treatment of Patients With Nonsevere Aplastic Anemia: A Report From the European Blood and Marrow Transplant (EBMT) Severe Aplastic Anaemia Working Party 
    Blood 93: 2191-2195, 1999
                                                                                                
    Patients with nonsevere aplastic anemia received ATG + cyclosporin or cyclosporin alone and hematologic response at 6 months was recorded.
                                                                                
    Those receiving combination of ATG + cyclosporin had significantly higher median hemoglobin level than patients receiving cyclosporin alone and those on cyclosporin alone had significant disease progression within 6 months.
                                                                                       
    Thus combination arm had higher responses and complete responses and transfusion-free survival.                
                                                                              

  • Dunn DE, Tanawattanacharoen P, Boccuni P, et al (Natl Heart, Lung, and Blood Inst, Bethesda, Md; MCP Hahnemann Univ, Philadelphia)
    Paroxysmal Nocturnal Hemoglobinuria Cells in Patients With Bone Marrow Failure Syndromes
    Ann Intern Med 131: 401-408, 1999
                                                                                
    Aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH) are rare hematologic diseases that commonly occur in the same patient.
                                                                                             
    This study of patients with diverse marrow failure such as aplastic anemia with MDS, post BMT, cancer treated with chemotherapy etc were examined for PNH status by flow cytometric analysis.
                                                                                                                      
    Evidence of PNH was observed in 22% of patients with aplastic anemia, 23% patients with MDS. The presence of PNH cells i.e. GPI anchored protein deficient cells were predictive of response to ATG.                                        
                                    

  • Somlo G, Sniecinski I, ter Veer A, et al (City of Hope Natl Med Ctr, Duarte, Calif; Mayo Clinic Cancer Ctr, Rochester, Minn; Genentech Inc, South San Francisco)
    Recombinant Human Thrombopoietin in Combination With Granulocyte Colony-Stimulating Factor Enhances Mobilization of Peripheral Blood Progenitor Cells, Increases Peripheral Blood Platelet Concentration, and Accelerates Hematopoietic Recovery Following High-Dose Chemotherapy
    Blood 93: 2798-2806, 1999
                                                                                                       
    This phase I study of varying dose schedule of rhTPO with G-CSF revealed enhanced mobilization of PBPC, higher peripheral blood platelet count and platelet count of PBPC product.
                                                                      
    Most beneficial to the patients were decrease in the number of apheresis procedures and transfusions required following high dose chemotherapy.                                         
                                                                                      

  • Navarro JF, Mora C, Garcia J, et al (Hosp Ntra Sra de Candelaria, Santa Cruz de Tenerife, Spain)
    Effects of Pentoxifylline on the Haematologic Status in Anaemic Patients With Advanced Renal Failure
    Scand J Urol Nephrol 33: 121-125, 1999
                                                                                                            
    Erythropoietin (EPO) deficiency is one of the cause of anemia in patients with renal failure. Inhibition of EPO by cytokines such as TNF-
    a (tumor necrosis factor-a) may also play some role. Pentoxifylline inhibits TNF-a
                                                                                                              
    This study of 12 patients with anemia and advanced renal failure were randomized to control group and active treatment group i.e. with pentoxifylline (TF) 400 mg/day for 6 months. Daily PTF group had significant higher hemoglobin level and hematocrit along with reduced TNF-
    a levels.                                                              
                                                                                                                                                                                                          

  • Gonzalez-Fajardo JA, Arreba E, Castrodeza J, et al (Hosp Clinico Universitario, Valladolid, Spain)
    Venographic Comparison of Subcutaneous Low-Molecular Weight Heparin (LMWH) With Oral Anticoagulant Therapy in the Long-term Treatment of Deep Venous Thrombosis 
    J Vasc Surg 30: 283-292, 1999
                                                                                                                                                       
    This open randomized clinical trial of 165 patients of deep vein thrombosis randomized to LMWH or oral anticoagulant. Those on oral anticoagulant had received standard unfractionated heparin at the onset. 
                                                                                                                      
    LMWH was associated with significantly improved resolution of venous thrombosis which could be associated with reduced long term complications from the post-phlebitic syndrome.                                                                                                                    
                                                                                

  • Hebert PC, for the Canadian Critical Care Trials Group (Univ of Ottawa, Hamilton; et al)
    A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care
    N Engl J Med 340: 409-417, 1999                
                                                                                                                              
    This study of 838 critically ill patients who were normovolemic were randomly assigned to either a restrictive strategy (transfusion when hemoglobin concentration decreased below 7 gm/dL) or a liberal strategy (transfusion when hemoglobin decreased below 10 gm/dL).                                                   
                                                                                  
    There was no difference in early (30 day death) or late mortality (60 day death) and mortality rate overall for hospitalization was lower in patients transfused with the restrictive policy.                                                  
                                                                                
    This study clearly indicates superiority of restrictive policy versus liberal policy in critically ill normovolemic patients.       
                                                            
                                                                             
                                                                                         


                                    
                        
                                                                                   
                                  
     

 

 

 

By |2022-07-20T16:42:24+00:00July 20, 2022|Uncategorized|Comments Off on Haematology

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